Provider Demographics
NPI:1316661416
Name:GODFREY, JADA (LPC)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:
Last Name:GODFREY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 PARKWOOD BLVD STE D100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7453
Mailing Address - Country:US
Mailing Address - Phone:940-312-1031
Mailing Address - Fax:
Practice Address - Street 1:7000 PARKWOOD BLVD STE D100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7453
Practice Address - Country:US
Practice Address - Phone:940-312-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health